Your physician can perform a digital rectal exam of your prostate during a physical exam with two objectives:

Check for a hard lump that might suggest the possibility of cancer.

Estimate the size of your prostate.

Both results are valuable information for use in the ERSPC Risk Calculator.

​If a prostate cancer tumor is large enough to be felt by digital exam, it may be large enough to be imaged. Therefore, a positive digital rectal exam may suggest follow-up with either TRUS ultrasound imaging or MR imaging to look for the possible tumor.

The ERSPC Risk Calculator provides the following guidance:

The digital rectal examination is less effective than the PSA blood test at finding prostate cancer but it can sometimes find cancer in men with normal PSA levels. A DRE is considered abnormal if the examination reveals marked asymmetry, obvious induration, nodularity or a hard mass.

On the basis of DRE the volume of the prostate is estimated to be in the range of < 30 cc (walnut), between 30-50 cc ([small] tomato) and >= 50 cc (mandarin [small orange]).

Digital Rectal Exam (DRE) Can Help Identify Cancers

Summary

Most prostate abnormalities are noncancerous and alone do not justify a biopsy

Some cancers may be felt by a physician before PSA levels trigger a biopsy

Risk calculators use abnormal DRE results to suggest next steps before a biopsy

A strongly abnormal DRE may justify an MRI prior to considering a biopsy

A DRE is performed by a physician to detect abnormalities in the prostate

For a digital rectal examination (DRE) for prostate cancer, you will undress below the waist and will be given a gown to wear. You may be examined while you stand and bend forward at the waist or while you are lying on your left side with your knees bent toward your chest. Your physician will gently insert one lubricated, gloved finger into your rectum. He or she may apply gentle pressure to your lower belly or pelvic area with the other hand. Your physician will be checking for abnormalities such as an enlarged or hardened prostate gland or tumors. A tumor in the prostate sometimes can be felt as a hard lump. A "positive" DRE means that an abnormality was found.

During a digital rectal examination (DRE) for prostate cancer, a physician inserts a lubricated, gloved finger into the rectum to feel for abnormalities.

Most prostate abnormalities are noncancerous and alone do not justify a biopsy

A prostate abnormality is a clue that something unusual is occurring in your prostate. An abnormality may or may not be caused by cancer. The majority of men with positive DRE results do not have cancer.

Some cancers may be felt by a physician before PSA levels trigger a biopsy

Cautiously used, a DRE can be a useful part of a screening program. A few prostate cancers produce little PSA. A DRE is useful to detect these cancers before PSA levels are high enough to trigger a biopsy.

Risk calculators use abnormal DRE results to suggest next steps before a biopsy

Risk calculators estimate the probability that cancer may be present. An abnormal DRE result increases this probability. Along with other information, a positive DRE may justify further testing before a biopsy is performed. You may undergo a baseline prostate volume measurement; additional PSA tests; testing for a panel of biomarkers such as Prostate Health Index (PHI) or 4KScore; or even magnetic resonance imaging (MRI), in extreme cases.

A strongly abnormal DRE may justify an MRI prior to considering a biopsy

Occasionally, a physician may feel an extreme abnormality in the prostate and strongly suspect the presence of prostate cancer. In this case, examination by MRI may be justified. An extreme abnormality, if relatively large, might be caused by prostate cancer. MRI is an effective tool for determining whether relatively large abnormalities are caused by cancer or noncancerous conditions.